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BACKGROUND:  Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. OBJECTIVE:  This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. METHODS:  We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. RESULTS:  Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice. CONCLUSIONS:  Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies.

BACKGROUND: Improving shared decision-making using a treat-to-target approach, including the use of clinical outcome measures, is important to providing high quality care for rheumatoid arthritis (RA). We developed an Electronic Health Record (EHR) integrated, patient-facing sidecar dashboard application that displays RA outcomes, medications, and lab results for use during clinical visits (RA PRO dashboard). The purpose of this study was to assess clinician perceptions and experiences using the dashboard in a university rheumatology clinic. METHODS: We conducted focus group (FG) discussions with clinicians who had access to the dashboard as part of a randomized, stepped-wedge pragmatic trial. FGs explored clinician perceptions towards the usability, acceptability, and usefulness of the dashboard. FG data were analyzed thematically using deductive and inductive techniques; generated themes were categorized into the domains of the Technology Acceptance Model (TAM). RESULTS: 3 FG discussions were conducted with a total of 13 clinicians. Overall, clinicians were enthusiastic about the dashboard and expressed the usefulness of visualizing RA outcome trajectories in a graphical format for motivating patients, enhancing patient understanding of their RA outcomes, and improving communication about medications. Major themes that emerged from the FG analysis as barriers to using the dashboard included inconsistent collection of RA outcomes leading to sparse data in the dashboard and concerns about explaining RA outcomes, especially to patients with fibromyalgia. Other challenges included time constraints and technical difficulties refreshing the dashboard to display real-time data. Methods for integrating the dashboard into the visit varied: some clinicians used the dashboard at the beginning of the visit as they documented RA outcomes; others used it at the end to justify changes to therapy; and a few shared it only with stable patients. CONCLUSIONS: The study provides valuable insights into clinicians perceptions and experiences with the RA PRO dashboard. The dashboard showed promise in enhancing patient-clinician communication, shared decision-making, and overall acceptance among clinicians. Addressing challenges related to data collection, education, and tailoring dashboard use to specific patient populations will be crucial for maximizing its potential impact on RA care. Further research and ongoing improvements in dashboard design and implementation are warranted to ensure its successful integration into routine clinical practice.

Emergency department visits and healthcare expenditures for pediatric atopic dermatitis have been increasing over the last two decades. There is a paucity of replicable quality improvement initiatives addressed at educating primary care and emergency medicine clinicians on this condition. The goal of this initiative was to improve clinician knowledge and comfort in the diagnosis and management of pediatric atopic dermatitis and superinfection. Clinicians were recruited via email from academic and community settings in Travis County, Texas, in 2020. They were sent a pre-intervention survey, a series of three quizzes, and a post-intervention survey. After each quiz, participants received performance feedback and various forms of multimodal education. Differences between the first and final quiz scores and clinician confidence levels were analyzed for statistical significance. Fifty-six clinicians completed the intervention. The average overall and treatment-specific scores increased significantly by 10% and 37%, respectively. Further, confidence levels improved significantly in the majority of clinicians. Clinician qualitative feedback revealed high satisfaction. Results from this educational quality improvement project have demonstrated that this is an effective and replicable resource for educating clinicians who manage pediatric atopic dermatitis in the emergency department and outpatient setting.

Transparency within biomedical research is essential for research integrity, credibility, and reproducibility. To increase adherence to optimal scientific practices and enhance transparency, we propose the creation of a journal transparency tool (JTT) that will allow users to obtain information about a given scholarly journal's operations and transparency policies. This study is part of a program of research to obtain user preferences to inform the proposed JTT. Here, we report on our consultation with clinicians and researchers. This mixed-methods study was conducted in two parts. The first part involved a cross-sectional survey conducted on a random sample of authors from biomedical journals. The survey asked clinicians and researchers about the inclusion of a series of potential scholarly metrics and user features in the proposed JTT. Quantitative survey items were summarized with descriptive statistics. Thematic content analysis was employed to analyze text-based responses. Subsequent focus groups used survey responses to further explore the inclusion of items in the JTT. Items with less than 70% agreement were used to structure discussion points during these sessions. Participants voted on the use of user features and metrics to be considered within the journal tool after each discussion. Thematic content analysis was conducted on interview transcripts to identify the core themes discussed. A total of 632 participants (5.5% response rate) took part in the survey. A collective total of 74.7% of respondents found it either 'occasionally, 'often', or 'almost always' difficult to determine if health information online is based on reliable research evidence. Twenty-two participants took part in the focus groups. Three user features and five journal tool metrics were major discussion points during these sessions. Thematic analysis of interview transcripts resulted in six themes. The use of registration was the only item to not meet the 70% threshold after both the survey and focus groups. Participants demonstrated low scholarly communication literacy when discussing tool metric suggestions. Our findings suggest that the JTT would be valuable for both researchers and clinicians. The outcomes of this research will contribute to developing and refining the tool in accordance with researchers and clinicians. [ABSTRACT FROM AUTHOR]

Background: The evidence for the benefits of early mobilization in intensive care is growing. Early mobilization differs from most other interventions in intensive care since the patient's participation is requested. What kind of challenges this entails for the intensive care clinicians, and what is crucial in successful early mobilization from their perspective, is sparsely explored and was therefore the purpose of this study. Methods: Semi-structured interviews were held with 17 intensive care clinicians, seven nurses, five assistant nurses and five physiotherapists. The interviews were analyzed with a phenomenographic methodology. Findings: Four descriptive categories emerged: 1) Taking responsibility; 2) Taking the patient's perspective; 3) Time or not time to mobilize; and 4) The "know-how" of early mobilization. Early mobilization was perceived as an important and crucial part of intensive care. It includes positioning and sensory stimulation, which could be used to re-orientate the patient and prevent delirium. The patients' experiences were considered individual with a mix of strong emotions. Despite the stated significance of early mobilization, different conceptions were expressed about the right time, some of them based on concerns for the patient, and some due to safety concerns. In the optimal active mobilization to upright positions there was an emphasis on careful preparation and patient involvement, including negotiation and active participation. Conclusions: The importance of early mobilization is indisputable. Successful early mobilization is achieved by applying a person-centered approach, involving the patient as an active partner. Early mobilization comprises positioning and sensory stimulation and should be included in the daily planning of patient care. [ABSTRACT FROM AUTHOR]

Background: The mental health service delivery gap remains high globally. Appropriate telehealth use may increase capacity through flexible remote care provision. Despite the historical lack of telehealth integration into publicly funded mental health services, during COVID‐19 lockdowns, services rapidly switched to telephone and audiovisual care provision. In Aotearoa New Zealand (NZ), this was abandoned when no longer required by COVID‐19 restrictions. This study explores environmental factors associated with telehealth implementation and ongoing use or discontinuation across a multiregional outpatient mental health service. This work contributes to understanding system‐level factors influencing telehealth use and thus informs policy and practice in postpandemic environments. Methods: This mixed methods study applied an interpretive description methodology. Semistructured interviews with 33 mental health clinicians were thematically analysed. Qualitative findings were reframed and evaluated using time series analyses of population‐level quantitative data (prior to and throughout the pandemic). Findings were synthesised with qualitative themes to develop an understanding of environmental factors contributing to telehealth use. Results: Findings highlighted an increase in clients assessed by mental health services and declining clinician numbers, contributing to pressure placed on clinicians. There was a lack of culture supporting telehealth, including limited awareness, leadership, and champions to facilitate implementation. Some teams provided services suited to telehealth; other subspeciality teams had limited applications for telehealth. There was a general lack of policy and guidelines to support telehealth use and limited technical support for clinicians unfamiliar with audiovisual software. Conclusion: Disorganised telehealth adoption in the study regions provides insight into wider environmental drivers affecting telehealth uptake. For telehealth to become a workable service delivery mode following COVID‐19, stewardship and culture shifts are required, including policy development, technical support, and resources to support clinical teams. Telehealth may address growing service demand by improving interfaces with primary care and providing timely access to specialist input. [ABSTRACT FROM AUTHOR]

Context: This study proposes a Bayesian network model to aid mental health specialists making data-driven decisions on suitable treatments. The aim is to create a probabilistic machine learning model to assist psychologists in selecting the most suitable treatment for individuals for four potential mental disorders: Depression, Panic Disorder, Social Phobia, or Specific Phobia. Methods: This study utilized a dataset from 1,094 individuals in Denmark containing socio-demographic details and mental health information. A Bayesian network was initially employed in a purely data-driven approach and was later refined with expert knowledge, referred to as a hybrid model. The model outputted probabilities for each disorder, with the highest probability indicating the most suitable disorder for treatment. Results: By incorporating expert knowledge, the model demonstrated enhanced performance compared to a strictly data-driven approach. Specifically, it achieved an AUC score of 0.85 vs 0.80 on the test data. Furthermore, we evaluated some cases where the predictions of the model did not match the actual treatment. The symptom questionnaires indicated that these participants likely had comorbid disorders, with the actual treatment being proposed by the model with the second highest probability. Conclusions: In 90.1% of cases, the hybrid model ranked the actual disorder treated as either the highest (67.3%) or second-highest (22.8%) on the test data. This emphasizes that instead of suggesting a single disorder to be treated, the model can offer the probabilities for multiple disorders. This allows individuals seeking treatment or their therapists to incorporate this information as an additional data-driven factor when collectively deciding on which treatment to prioritize. [ABSTRACT FROM AUTHOR]

Background: Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption. Objective: To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey. Method: Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used. Results: Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks. Conclusion: If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. Implications: These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care. [ABSTRACT FROM AUTHOR]

We draw on ethnographic fieldwork conducted in Brussels (Belgium) on the health care experiences of undocumented migrants. We explore the implications of the double position of the ethnographer, who is both a researcher and a practicing doctor. We describe how the intimate knowledge the ethnographer-cum-clinician holds about the health care system influenced and shaped the data collection, analysis and subsequent policy recommendations. We examine the ethical dilemmas in conducting research from an engaged position about care practices toward vulnerable populations in one's own professional field. We conclude with recommendations on how to challenge and interrupt complexities faced by multi-positioned ethnographers. [ABSTRACT FROM AUTHOR]

Abstract Transparency within biomedical research is essential for research integrity, credibility, and reproducibility. To increase adherence to optimal scientific practices and enhance transparency, we propose the creation of a journal transparency tool (JTT) that will allow users to obtain information about a given scholarly journal’s operations and transparency policies. This study is part of a program of research to obtain user preferences to inform the proposed JTT. Here, we report on our consultation with clinicians and researchers. This mixed-methods study was conducted in two parts. The first part involved a cross-sectional survey conducted on a random sample of authors from biomedical journals. The survey asked clinicians and researchers about the inclusion of a series of potential scholarly metrics and user features in the proposed JTT. Quantitative survey items were summarized with descriptive statistics. Thematic content analysis was employed to analyze text-based responses. Subsequent focus groups used survey responses to further explore the inclusion of items in the JTT. Items with less than 70% agreement were used to structure discussion points during these sessions. Participants voted on the use of user features and metrics to be considered within the journal tool after each discussion. Thematic content analysis was conducted on interview transcripts to identify the core themes discussed. A total of 632 participants (5.5% response rate) took part in the survey. A collective total of 74.7% of respondents found it either ‘occasionally, ‘often’, or ‘almost always’ difficult to determine if health information online is based on reliable research evidence. Twenty-two participants took part in the focus groups. Three user features and five journal tool metrics were major discussion points during these sessions. Thematic analysis of interview transcripts resulted in six themes. The use of registration was the only item to not meet the 70% threshold after both the survey and focus groups. Participants demonstrated low scholarly communication literacy when discussing tool metric suggestions. Our findings suggest that the JTT would be valuable for both researchers and clinicians. The outcomes of this research will contribute to developing and refining the tool in accordance with researchers and clinicians.

Background: Bipolar affective disorders are dimensional illnesses in which patients experience, during the long-term course of illness, fluctuating levels of severity of manic and depressive symptoms interspersed with symptom-free periods. It is a highly exhausting and relapsing psychiatric disorder associated with significant morbidity and comorbidity. The World Health Organization Disability Assessment Schedule (WHODAS) is an International Classification of Functioning-based multidimensional instrument that was developed for measuring disability. Aim and Objective: The present study aimed to check the correlation and inter-rater agreement amongst the patient, caregiver, and clinician-administered version of the WHODAS 2.0 among persons with bipolar affective disorder. Materials and Methods: The study was cross-sectional in nature. Thirty samples of patients with bipolar affective disorder as per ICD-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included and used self, proxy, and interviewer-administered versions of WHODAS 2.0. Results: The total score of WHODAS 2.0 shows that the interclass correlation coefficient between the patient and caregiver, caregiver and clinician, and patient and clinician was 0.655 (0.469–0.802), 0.599 (0.395–0.767), and 0.722 (0.586–0.820), respectively, indicative of moderate reliability. Caregivers showed a higher mean in cognition, 3.73 (3.13); mobility, 2.63 (1.73); and self-care, 0.867 (1.25), than other raters. Clinicians showed a higher mean (standard deviation) in getting along with people, 4.13 (1.69); life activities of the household, 5.46 (2.67); and participation in society, 10.70 (2.56), than other raters. Conclusion: People suffering from bipolar affective disorder are prone to disability albeit in the mild-to-moderate variety. The findings show that there was moderate reliability between the patient and caregiver, caregiver and clinician, and patient and clinician among the patient rated, caregiver rated on the overscore of WHODAS 2.0.

Objectives: To investigate the approach taken by clinicians involved in the diagnosis and management of individuals with Differences of Sex Development (DSD), particularly with regard to genomic testing, and identify perceived gaps/strengths/barriers in current practice. Design and Methods: An anonymous online survey was developed, with questions exploring demographics, perceptions of genomic testing, availability of genetics services and opinions on the role and utility of genomic testing in DSD. All responses were anonymous. Clinicians involved in the diagnosis and management of individuals with DSD were recruited from relevant societies and departments across Australia and New Zealand. Results: 79 eligible clinicians commenced the survey, with 63 completing it and 16 providing a partial response. The perceived benefit of having a genetic diagnosis for DSD was almost unanimous (97%). Almost half (48%) of respondents reported barriers in genomic testing. 81% of respondents reported they order genomic tests currently. Approaches to genomic testing when faced with four different clinical scenarios varied across respondents. Clinicians perceived genomic testing to be underutilised (median 36 on sliding scale from 0 to 100). Conclusions: Despite 97% of respondents reporting benefit of a genetic diagnosis for individuals with DSD, this was not reflected throughout the survey with regard to clinical implementation. When faced with clinical scenarios, the recommendations for genomic testing from respondents was much lower, indicating the discrepancy between perception and clinical practice. Genomic testing in the context of DSD is seen as both beneficial and desired, yet there are multiple barriers impacting its integration into standard clinical care. [ABSTRACT FROM AUTHOR]

Introduction: Although virtual care (VC) has become an integral part of oncology care and healthcare delivery, clinicians’ perspectives on and satisfaction with this modality are not well understood. Methods: Using a National Network Forum framework and expert panel review, we developed a questionnaire to measure oncologists’ satisfaction with VC. The questionnaire was distributed to Canadian oncologists through medical society email lists (n = 1541). We used a 5-point Likert scale to capture their responses, which included strongly disagree (1), disagree (2), undecided (3), agree (4), and strongly agree (5). Results: A total of 61 oncologists and/or oncology trainees, of 768 (7.9%) who opened their email, completed questionnaires between October 2022 and January 2023. Every questionnaire item had a response rate greater than 98%. Seventy-two percent of the respondents were satisfied with VC. Oncologists who were less comfortable with technology were more likely to report lower levels of satisfaction (p < 0.001, Wilcoxon rank-sum). The questionnaire items that received the highest levels of agreement were related to VC reducing costs and improving access for patients and concerns about missing a diagnosis and assessing patients’ functional status. The questionnaire items that received the greatest disagreement were related to VC improving access for patients with language barriers, VC being associated with time-savings for clinicians, improvements in clinical efficacy, and more readily available lab tests. Conclusions: Most of the oncologists surveyed are satisfied with VC; however, there are some concerns with VC that need to be addressed. Future research on optimizing VC should address clinicians’ concerns, in addition to addressing the patient experience.

Anxiety in older individuals is understudied despite its prevalence. Investigating its occurrence can be challenging, yet understanding the factors influencing its recurrence is important. Gaining insights into these factors through an explainable, probabilistic approach can enhance improved management. A Bayesian network (BN) is well-suited for this purpose. This study aimed to model the recurrence of anxiety symptomatology in an older population within a five-month timeframe. Data included baseline socio-demographic and general health information for older adults aged 60 years or older with at least mild depressive symptoms. A BN model explored the relationship between baseline data and recurrent anxiety symptomatology. Model evaluation employed the Area Under the Receiver Operating Characteristic Curve (AUC). The BN model was also compared to four machine learning models. The model achieved an AUC of 0.821 on the test data, using a threshold of 0.367. The model demonstrated generalisation abilities while being less complex and more explainable than other machine learning models. Key factors associated with recurrence of anxiety symptomatology were: "Not being able to stop or control worrying"; "Becoming easily annoyed or irritable"; "Trouble relaxing"; and "depressive symptomatology severity". These findings indicate a prioritised sequence of predictors to identify individuals most likely to experience recurrent anxiety symptomatology. [ABSTRACT FROM AUTHOR]

The aim of this study was to discuss different perspectives on psychoanalytic clinical practice in relation to non-binary transidentity issues, in order to explore the challenges of analytical practice in the multiplicities in which gender is experienced, bringing out a more cautious and welcoming approach to “de-binarizing” clinical practice, reflecting on the epistemological and cultural mitigants that surround transidentities in post-contemporary times. A qualitative approach was used as a method, based on bibliographic research, which raises salutary questions for the consolidation of this research. The study in question was conducted using the theoretical framework of psychoanalysis. The discussion about transidentities, through the psychoanalytic approach, needs to be in an open field and attentive to sexual differences, always trans-disciplinary listening and considering that the subject who comes to the clinic goes beyond the logistics of biological and/or social categorizations. Thus, listening to them from the perspective of non-binary clinical practice is necessary and trans-changing. [ABSTRACT FROM AUTHOR]

Purpose: Mandating headgear for field players in girls’ lacrosse to reduce head injuries, including concussion, has been heavily debated. However, research regarding the need and effectiveness of mandated headgear use in girls’ lacrosse is still developing. Therefore, this qualitative study aimed to identify the need for and barriers to the development of mandated headgear use policies in girls’ lacrosse in Ohio. Methods: We conducted six virtual focus groups, three with concussion experts (clinicians and researchers) and three with girls’ lacrosse stakeholders (high school players, parents, coaches, and officials). A focus group guide was developed to explore study participants’ perceptions and opinions on concussion in girls’ lacrosse, headgear use among players, and policies and policy development related to headgear use or a headgear mandate. We developed the codebook using an inductive and iterative approach based on focus group transcripts and used ATLAS.TI to code and analyze the transcript data. Results: Concussion experts and stakeholders understood the potential consequences of concussion but did not perceive concussion as a pervasive problem in girls’ lacrosse. The prevention of head and facial injuries was regarded as a potential benefit of headgear use. However, stakeholders expressed that the myriad of arguments discussed opposing mandated headgear use including increased aggressive play and/or targeting, concerns over changes in the game, and cost strongly outweighed the benefits. Finally, both concussion experts and stakeholders identified multiple organizations, including USA Lacrosse, who could act as facilitators and/or barriers to developing, enacting, and implementing headgear policies. Conclusions: Concussion experts and stakeholders identified possible reasons for headgear use related to injury prevention but also identified several important barriers to the development of a headgear mandate for girls’ lacrosse in Ohio. [ABSTRACT FROM AUTHOR]

Background: Antidepressant use has continually increased in recent decades and although they are an effective treatment for moderate-to-severe depression, when there is no longer a clinical benefit, deprescribing should occur. Currently, routine deprescribing is not part of clinical practice and research shows that there has been an increase in antidepressant users seeking informal support online. This small scoping exercise used a mixed-methods online survey to investigate the motives antidepressant users have for joining social media deprescribing support groups, and what elements of the groups are most valuable to them. Methods: Thirty members of two antidepressant deprescribing Facebook groups completed an online survey with quantitative and open-text response questions to determine participant characteristics and motivation for group membership. Quantitative data were analysed using descriptive statistics, and open-text responses were analysed thematically through NVivo. Results: Two overarching themes were evident: first, clinician expertise , where participants repeatedly reported a perceived lack of skills around deprescribing by their clinician, not being included in shared decision-making about their treatment, and symptoms of withdrawal during deprescribing going unaddressed. Motivated by the lack of clinical support, peer support developed as the second theme. Here, people sought help online where they received education, knowledge sharing and lived experience guidance for tapering. The Facebook groups also provided validation and peer support, which motivated people to continue engaging with the group. Conclusions: Antidepressant users who wish to cease their medication are increasingly subscribing to specialised online support groups due to the lack of information and support from clinicians. This study highlights the ongoing need for such support groups. Improved clinician understanding about the complexities of antidepressant deprescribing is needed to enable them to effectively engage in shared decision-making with their patients. Deprescribing of antidepressants is not routinely occurring in clinical practice, leading patients to seek help via other methods. Little is known about what role social media support groups play in a patient's journey when ceasing antidepressant medication. This is one of the first studies to gain insight from antidepressant users who are also members of two Facebook groups providing support for antidepressant deprescribing. Lack of clinical knowledge by clinicians is a big driver for patients help seeking from their peers. [ABSTRACT FROM AUTHOR]

Introduction: Although virtual care (VC) has become an integral part of oncology care and healthcare delivery, clinicians' perspectives on and satisfaction with this modality are not well understood. Methods: Using a National Network Forum framework and expert panel review, we developed a questionnaire to measure oncologists' satisfaction with VC. The questionnaire was distributed to Canadian oncologists through medical society email lists (n = 1541). We used a 5-point Likert scale to capture their responses, which included strongly disagree (1), disagree (2), undecided (3), agree (4), and strongly agree (5). Results: A total of 61 oncologists and/or oncology trainees, of 768 (7.9%) who opened their email, completed questionnaires between October 2022 and January 2023. Every questionnaire item had a response rate greater than 98%. Seventy-two percent of the respondents were satisfied with VC. Oncologists who were less comfortable with technology were more likely to report lower levels of satisfaction (p < 0.001, Wilcoxon rank-sum). The questionnaire items that received the highest levels of agreement were related to VC reducing costs and improving access for patients and concerns about missing a diagnosis and assessing patients' functional status. The questionnaire items that received the greatest disagreement were related to VC improving access for patients with language barriers, VC being associated with time-savings for clinicians, improvements in clinical efficacy, and more readily available lab tests. Conclusions: Most of the oncologists surveyed are satisfied with VC; however, there are some concerns with VC that need to be addressed. Future research on optimizing VC should address clinicians' concerns, in addition to addressing the patient experience. [ABSTRACT FROM AUTHOR]

Background: The radiology report is the primary means of conveying imaging findings between radiologists and clinicians. As a result, clinician satisfaction with the radiology report is an indicator of its quality and clinical relevance. It is crucial to identify factors that can enhance the radiology report in order to improve service delivery. Objectives: This study evaluates clinician and radiologist opinions, preferences and clinician utilisation of the radiology report. Method: Mixed quantitative and qualitative survey questionnaires were distributed in-person and online from December 2022 to February 2023 to a total of 287 clinicians and 43 independent medical practitioners specialising in radiology. Results: A total of 73.0% of radiologists and 56.5% of clinicians expressed satisfaction with the radiology reports. Additionally, 72.0% of radiologists expressed dissatisfaction with the history provided on the referral forms. It was found that 87.6% of clinicians read the radiology report, while 26.2% reviewed the radiological imaging without referring to it. Interestingly, 77.8% of clinicians preferred itemised listed reports, whereas 53.8% of radiologists preferred reports in paragraph format. It was discovered that 69.6% of radiologists and 65.4% of clinicians preferred a standardised reporting format. Conclusion: More than half of the clinicians and most of the radiologists expressed satisfaction with the radiology report. Both clinicians and radiologists showed a preference for a structured reporting format. A crucial element in constructing a good radiology report was having a relevant clinical history. The radiologist continued to be the preferred professional for interpreting radiological imaging. Contribution: This survey was a good starting point for improving communication between clinicians and radiologists. This will ultimately result in reports that are more useful to clinicians and radiologists who have a better understanding of what should be included in reports and how they should be structured.

ContextThis study proposes a Bayesian network model to aid mental health specialists making data-driven decisions on suitable treatments. The aim is to create a probabilistic machine learning model to assist psychologists in selecting the most suitable treatment for individuals for four potential mental disorders: Depression, Panic Disorder, Social Phobia, or Specific Phobia.MethodsThis study utilized a dataset from 1,094 individuals in Denmark containing socio-demographic details and mental health information. A Bayesian network was initially employed in a purely data-driven approach and was later refined with expert knowledge, referred to as a hybrid model. The model outputted probabilities for each disorder, with the highest probability indicating the most suitable disorder for treatment.ResultsBy incorporating expert knowledge, the model demonstrated enhanced performance compared to a strictly data-driven approach. Specifically, it achieved an AUC score of 0.85 vs 0.80 on the test data. Furthermore, we evaluated some cases where the predictions of the model did not match the actual treatment. The symptom questionnaires indicated that these participants likely had comorbid disorders, with the actual treatment being proposed by the model with the second highest probability.ConclusionsIn 90.1% of cases, the hybrid model ranked the actual disorder treated as either the highest (67.3%) or second-highest (22.8%) on the test data. This emphasizes that instead of suggesting a single disorder to be treated, the model can offer the probabilities for multiple disorders. This allows individuals seeking treatment or their therapists to incorporate this information as an additional data-driven factor when collectively deciding on which treatment to prioritize.

Traditionally, every practicing hakim used to have a group of students, most of whom lived in the compound of the hakim, witnessed and learnt the intricacies of 'hikmat', as well as preparation of different pharmaceutical products from raw materials. Once, they acquired a certain level of proficiency, they were allowed to leave and start their own practice. Same routine used to be followed by other branches of medicine. As the number of medical practitioners grew, their links to the teaching side got weaker or mostly ceased to exist, and with it the opportunities to learn. A debate has been generated whether the diagnostic proficiency and the clinical acumen of a non-teaching clinician can be considered equivalent to the one who is a teaching clinician actively engaged in teaching and grooming full classes of his or her students. [ABSTRACT FROM AUTHOR]

Abstract Background Improving shared decision-making using a treat-to-target approach, including the use of clinical outcome measures, is important to providing high quality care for rheumatoid arthritis (RA). We developed an Electronic Health Record (EHR) integrated, patient-facing sidecar dashboard application that displays RA outcomes, medications, and lab results for use during clinical visits (“RA PRO dashboard”). The purpose of this study was to assess clinician perceptions and experiences using the dashboard in a university rheumatology clinic. Methods We conducted focus group (FG) discussions with clinicians who had access to the dashboard as part of a randomized, stepped-wedge pragmatic trial. FGs explored clinician perceptions towards the usability, acceptability, and usefulness of the dashboard. FG data were analyzed thematically using deductive and inductive techniques; generated themes were categorized into the domains of the Technology Acceptance Model (TAM). Results 3 FG discussions were conducted with a total of 13 clinicians. Overall, clinicians were enthusiastic about the dashboard and expressed the usefulness of visualizing RA outcome trajectories in a graphical format for motivating patients, enhancing patient understanding of their RA outcomes, and improving communication about medications. Major themes that emerged from the FG analysis as barriers to using the dashboard included inconsistent collection of RA outcomes leading to sparse data in the dashboard and concerns about explaining RA outcomes, especially to patients with fibromyalgia. Other challenges included time constraints and technical difficulties refreshing the dashboard to display real-time data. Methods for integrating the dashboard into the visit varied: some clinicians used the dashboard at the beginning of the visit as they documented RA outcomes; others used it at the end to justify changes to therapy; and a few shared it only with stable patients. Conclusions The study provides valuable insights into clinicians’ perceptions and experiences with the RA PRO dashboard. The dashboard showed promise in enhancing patient-clinician communication, shared decision-making, and overall acceptance among clinicians. Addressing challenges related to data collection, education, and tailoring dashboard use to specific patient populations will be crucial for maximizing its potential impact on RA care. Further research and ongoing improvements in dashboard design and implementation are warranted to ensure its successful integration into routine clinical practice.

Abstract Background The COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians’ perspectives of COVID-19 on SUD treatment delivery for people on community supervision. Methods Virtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky’s Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods. Results Clinicians were predominantly white (92%) and female (88%) with an average of over 9 years working in the SUD treatment field and 4.6 years in their current job. Four COVID-19 themes were identified by both rural and urban clinicians including: (1) telehealth increases the modes of communication, but (2) also creates paperwork and technological challenges, (3) telehealth requires more effort for inter/intra-agency collaboration, and (4) it limits client information (e.g., no urine drug screens). Two additional rural-specific themes emerged related to COVID-19: (5) increasing telehealth options removes SUD treatment transportation barriers and (6) requires flexibility with programmatic requirements for rural clients. Conclusions Findings indicate the need for community-based SUD treatment providers approved or contracted by DOC to support and train clients to access technology and improve information-sharing with community supervision officers. A positive lesson learned from COVID-19 transitions was a reduction in costly travel for rural clients, allowing for greater engagement and treatment adherence. Telehealth should continue to be included within the SUD continuum of care, especially to promote equitable services for individuals from rural areas.

Abstract Background Patient health-related social needs (HRSN) complicate care and drive poor outcomes in emergency department (ED) settings. This study sought to understand what HRSN information is available to ED physicians and staff, and how HRSN-related clinical actions may or may not align with patient expectations. Methods We conducted a qualitative study using in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. We asked ED providers, ED staff, and ED patients from one health system in the mid-Western United Stated about HRSN information availability during an ED encounter, HRSN data collection, and HRSN data use. Interviews were recorded, transcribed, and analyzed using modified thematic approach. Results We conducted 24 interviews (8 per group: ED providers, ED staff, and ED patients) from December 2022 to May 2023. We identified three themes: (1) Availability: ED providers and staff reported that HRSNs information is inconsistently available. The availability of HRSN data is influenced by patient willingness to disclose it during an encounter. (2) Collection: ED providers and staff preferred and predominantly utilized direct conversation with patients to collect HRSNs, despite other methods being available to them (e.g., chart review, screening questionnaires). Patients’ disclosure preferences were based on modality and team member. (3) Use: Patients wanted to be connected to relevant resources to address their HRSNs. Providers and staff altered clinical care to account for or accommodate HRSNs. System-level challenges (e.g., limited resources) limited provider and staff ability to address patients HRSNs. Conclusions In the ED, HRSNs information was inconsistently available, collected, or disclosed. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. Accounting for such difference in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.

The Box and Block Test (BBT) is a reliable outcome measure in upper limb rehabilitation. The present work aims to automate the test of unilateral manual dexterity of a patient's hand. A box consisting of 80 blocks was divided into two partitions. A motion tracking sensor (MPU6050) was placed on a wrist to obtain the orientation of hand movement. Thirty-four healthy participants were chosen for the test. Each participant completed both traditional and automated versions of BBT within a one-week interval, with each session lasting 60 seconds. A colour sensor at the box monitored block movements across the partitions. A Liquid Crystal Display (LCD) and a 4-digit 7-segment display provided feedback on the number of cubes moved and timing information, respectively. An independent t-test revealed a non-significant difference between traditional BBT and automated BBT. Concurrent validity was established by correlating the results of the automated BBT with the traditional BBT. A positive correlation (r= 0.94) was found between traditional and automated BBT. This validates the automated BBT report with the same result as traditional BBT. Automated BBT can assist a broad range of patients in independently tracking the progress of their hand injuries or conditions without needing a clinician. This can be conveniently done from the comfort of their homes. HighlightsLack of fine motor skills and dexterity is a primary concern affecting the person’s daily living activity; hence, the automated box and block test (BBT) is valid for assessing hand dexterity quantitatively.The traditional BBT is an old and golden test used in dexterity assessment with neurological patients, which only provides outcomes in the form of box count, which is insufficient for hand assessment.The need for this work arises from the limitations of the traditional BBT, which only provides a basic outcome in the form of box counts, insufficient for comprehensive hand dexterity assessment, particularly in neurological patients.Automated BBT is developed, which reduces the clinician’s burden during assessment and makes the test foolproof by adding a mechanism to capture hand trajectory during block movements.Along with the block count, the accelerometer gives hand orientation during the test process, which helps the clinician further analyze the results, such as motion pattern analysis, temporal analysis and comparative analysis.The independent t-test between traditional BBT and automated BBT, p = 0.109, was observed with a 0.95 confidence interval. Levene’s test revealed no significant difference between the scores of the traditional and automated BBT (t = 2.03; p = 0.109), also between dominant and non-dominant hand (t = 1.99; p = 0.74). A positive Pearson’s correlation (r = 0.94, p

Introduction: COVID-19 has enormously impacted the lives of healthcare workers worldwide. The study aimed to investigate the trend of intention to retire early (ITRE) among clinicians and explore the associated factors contributing to the decision. Materials and methods:This cross-sectional study utilized an online questionnaire in ‘Google form’ platform and the link was distributed to the participants based in the East Coast of Malaysia. The questionnaire comprised of sociodemographic and specific questions adapted from ‘Work Centrality Questionnaire’, ‘Kessler Psychology Distress Scale (K6)’ and “Retirement Resources Inventory (RRI)’. Descriptive analysis was used for the sociodemographic patterns, Chi-square test for analysing the independent variables and multiple logistic regression analysis for analysing the associated factors that contributing to the ITRE. Results: Two hundred and seventy-eight clinicians voluntarily completed the questionnaire. The number of paediatricians and general clinicians who had ITRE was 30 (44.8%) and 105 (49.8%) respectively. Those with ITRE had lower Work Centrality score (mean=14.67 for paediatrician, 13.80 for general clinician), higher K6 score (mean=10.77 for paediatrician, 11.89 for general clinician) and lower RRI scores (RT3 mean=20.60 for paediatrician, 20.24 for general clinician, RT1 mean=54.40 for paediatrician, 53.62 for general clinician, RT2 mean=26.53 for paediatrician, 27.57 for general clinician) as compared to no ITRE group. Work Centrality was a significant predictor of ITRE (p=0.001) in the population, however, this was not seen in the paediatrician group (p>0.05). There is an association between ITRE and COVID-19 pandemic (p=0.02). Conclusion: The trend of ITRE among the clinicians was largely influenced by professional factors despite the presence of COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Prognostic communication between clinicians and parents in pediatric oncology is complex. However, no review has exclusively examined research on prognostic communication in pediatric oncology. In this review, we synthesize the evidence on prognostic communication in pediatric oncology and provide recommendations for future research. Methods: We conducted an integrative review searching six databases for studies on prognostic communication in pediatric oncology as of August 2022. We applied descriptive and narrative approaches to data analysis. Results: Fourteen quantitative and five qualitative studies were included. All studies were conducted in Western developed countries. In total, 804 parents of 770 children with cancer were included. Across studies, parents were predominately female, Non-Hispanic White, and had high school or higher levels of education. Most parents reported that prognostic communication was initiated in the first year after their children's diagnosis. High-quality prognostic communication was positively associated with trust and hope and negatively associated with parental distress and decisional regret. In qualitative studies, parents suggested that prognostic communication should be open, ongoing, and delivered with sensitivity. Most studies were of moderate quality. The main gaps included inconsistent definitions of prognostic communication, and a lack of comprehensive and validated measurements, high-quality longitudinal studies, and diverse settings and participants. Conclusions: Clinicians should initiate high-quality prognostic communication early on in clinical practice. Future research should consider conducting high-quality longitudinal studies, developing prognostic communication definitions and measurements, and conducting studies across settings with diverse populations. [ABSTRACT FROM AUTHOR]

Background: Bipolar affective disorders are dimensional illnesses in which patients experience, during the long-term course of illness, fluctuating levels of severity of manic and depressive symptoms interspersed with symptom-free periods. It is a highly exhausting and relapsing psychiatric disorder associated with significant morbidity and comorbidity. The World Health Organization Disability Assessment Schedule (WHODAS) is an International Classification of Functioning-based multidimensional instrument that was developed for measuring disability. Aim and Objective: The present study aimed to check the correlation and inter-rater agreement amongst the patient, caregiver, and clinician-administered version of the WHODAS 2.0 among persons with bipolar affective disorder. Materials and Methods: The study was cross-sectional in nature. Thirty samples of patients with bipolar affective disorder as per ICD-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included and used self, proxy, and interviewer-administered versions of WHODAS 2.0. Results: The total score of WHODAS 2.0 shows that the interclass correlation coefficient between the patient and caregiver, caregiver and clinician, and patient and clinician was 0.655 (0.469--0.802), 0.599 (0.395--0.767), and 0.722 (0.586--0.820), respectively, indicative of moderate reliability. Caregivers showed a higher mean in cognition, 3.73 (3.13); mobility, 2.63 (1.73); and self-care, 0.867 (1.25), than other raters. Clinicians showed a higher mean (standard deviation) in getting along with people, 4.13 (1.69); life activities of the household, 5.46 (2.67); and participation in society, 10.70 (2.56), than other raters. Conclusion: People suffering from bipolar affective disorder are prone to disability albeit in the mild-to-moderate variety. The findings show that there was moderate reliability between the patient and caregiver, caregiver and clinician, and patient and clinician among the patient rated, caregiver rated on the overscore of WHODAS 2.0. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians' perspectives of COVID-19 on SUD treatment delivery for people on community supervision. Methods: Virtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky's Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods. Results: Clinicians were predominantly white (92%) and female (88%) with an average of over 9 years working in the SUD treatment field and 4.6 years in their current job. Four COVID-19 themes were identified by both rural and urban clinicians including: (1) telehealth increases the modes of communication, but (2) also creates paperwork and technological challenges, (3) telehealth requires more effort for inter/intra-agency collaboration, and (4) it limits client information (e.g., no urine drug screens). Two additional rural-specific themes emerged related to COVID-19: (5) increasing telehealth options removes SUD treatment transportation barriers and (6) requires flexibility with programmatic requirements for rural clients. Conclusions: Findings indicate the need for community-based SUD treatment providers approved or contracted by DOC to support and train clients to access technology and improve information-sharing with community supervision officers. A positive lesson learned from COVID-19 transitions was a reduction in costly travel for rural clients, allowing for greater engagement and treatment adherence. Telehealth should continue to be included within the SUD continuum of care, especially to promote equitable services for individuals from rural areas. [ABSTRACT FROM AUTHOR]

We find a lack of high-quality published evidence on risk factors for burn contracture formation. The vast majority of research is from High Income Countries (HICs), where many potential risk factors are controlled for by standardised and high-quality healthcare systems. To augment the published literature, burn care professionals with Low Middle Income Countries (LMICs) experience were interviewed for their opinion on risk factors for burn contracture formation. Participants were also asked for their views on identification and measurement of contracture. Seventeen semi-structured interviews were conducted (13 burn surgeons and 4 therapists). The average length of experience in burn-care was 13 years. Participants represented Ghana, Ethiopia, Malawi, Nigeria, South Africa, Nepal, and India. Participants reported ninety risk factors. Risk factors were later collated according to topic: Non burn individual factors (n = 13), Burn injury factors (n = 14), Family and community factors (n = 9), Treatment factors (n = 18), Complications (n = 2), Healthcare capacity factors (n = 19) and Societal and environmental factors (n = 12). The top five most frequently cited risk factors were lack of splinting, lack of physiotherapy, lack of early excision and skin grafting, low socioeconomic status and presence of infection. Although participants had no doubts that they could recognise a contracture, none provided a standardised system of measurement or an operational definition of contracture. Burn care professionals have a wealth of experience and untapped knowledge of risk factors for burn contracture formation in their own population base, but many of the risk factors highlighted by participants have not yet been explored in the literature. Variations in clinicians' diagnosis and measurement of a burn contracture underscores the need for an agreed, standardised, simple and easily reproducible method of diagnosing and classifying burn contractures. • Semi-structured interviews conducted to identify risk factors for burn contracture. • Healthcare professionals interviewed represented 7 low income countries. • The 17 participants identified 87 risk factors. • Risks given include burn, patient, treatment, health-system, socioeconomic factors. • Participants reported some risk factors not yet identified in the literature. [ABSTRACT FROM AUTHOR]

PurposeMandating headgear for field players in girls’ lacrosse to reduce head injuries, including concussion, has been heavily debated. However, research regarding the need and effectiveness of mandated headgear use in girls’ lacrosse is still developing. Therefore, this qualitative study aimed to identify the need for and barriers to the development of mandated headgear use policies in girls’ lacrosse in Ohio.MethodsWe conducted six virtual focus groups, three with concussion experts (clinicians and researchers) and three with girls’ lacrosse stakeholders (high school players, parents, coaches, and officials). A focus group guide was developed to explore study participants’ perceptions and opinions on concussion in girls’ lacrosse, headgear use among players, and policies and policy development related to headgear use or a headgear mandate. We developed the codebook using an inductive and iterative approach based on focus group transcripts and used ATLAS.TI to code and analyze the transcript data.ResultsConcussion experts and stakeholders understood the potential consequences of concussion but did not perceive concussion as a pervasive problem in girls’ lacrosse. The prevention of head and facial injuries was regarded as a potential benefit of headgear use. However, stakeholders expressed that the myriad of arguments discussed opposing mandated headgear use including increased aggressive play and/or targeting, concerns over changes in the game, and cost strongly outweighed the benefits. Finally, both concussion experts and stakeholders identified multiple organizations, including USA Lacrosse, who could act as facilitators and/or barriers to developing, enacting, and implementing headgear policies.ConclusionsConcussion experts and stakeholders identified possible reasons for headgear use related to injury prevention but also identified several important barriers to the development of a headgear mandate for girls’ lacrosse in Ohio.

Diagnosis and management of candiduria in hospitalized patients is often a gray zone for clinicians and microbiologists alike. The presence of Candida in urine could mean anything ranging from contamination and colonization to frank urinary tract infection. This study aims to enhance the understanding of candiduria among critically ill patients admitted in the intensive care unit (ICU). Out of 226 urine samples received in the laboratory from patients admitted in the ICU with an indwelling urinary catheter, 15 were found to have candiduria, prevalence being 6.6%. Various species isolated were Candida tropicalis (40%), Candida albicans (33.33%), Candida lusitaniae (13.33%), Candida parapsilosis (6.66%), and Candida dubliniensis (6.66%). In all patients, candiduria resolved spontaneously upon removal of the catheter. No antifungal was administered, and no concurrent positive blood culture was found in any of these patients. This study emphasizes that simply culturing the organism does not imply clinical significance. Removal or change of catheter must be undertaken once such a report is received from the laboratory.

Pansexuality is the emotional, romantic, and/or sexual attraction towards people regardless of their biological sex, gender identity, or gender expression. Literature regarding LGTBQ + populations has more recently been included in the available research. However, specific subgroups receive much less attention. This study was conducted through an anonymous online survey of mental health professionals in the United States. A preliminary investigation into this area may highlight both the unique stressors affecting pansexual youth and improve upon the therapeutic services provided to this population. Quantitative methods consisted of univariate, bivariate, and multivariate statistics. Results displayed a positive, statistically significant relationship (p =.017) between identified gender and working with pansexual youth. Another linear regression showed that there was a positive, statistically significant relationship (p =.000) between receiving relevant/any training/education and working with pansexual youth. In a third regression, a positive, statistically significant relationship (p =.001) was found between theoretical orientation and working with pansexual youth. The results showcased the need for clinicians to be more mindful of biases, to further their training on sexual minority populations, and for overall advocacy. Clinical implications and future directions are discussed. Pansexuality is the emotional, romantic, and/or sexual attraction towards others despite gender. Through an online survey of mental health professionals, we found the need for advocacy and clinicians to be more mindful of biases to further training on sexually minoritized populations. We highlight unique stressors, clinical implications, and future research. [ABSTRACT FROM AUTHOR]

Introduction: The decision to convey children to emergency departments is complex. This study aimed to identify barriers and enablers to making appropriate decisions, along with areas of disparity in this decision-making process by ambulance clinicians. Methods: A rapid evidence review was conducted. MEDLINE, CINAHL and PubMed were searched from 2012 to July 2023. Critical appraisal and thematic synthesis were performed. Results: Three studies were identified, which highlights the lack of research in this area. Five themes were identified: provision of care; equipment and protocols; exposure, experience and confidence; emotional and social circumstances; and education or skill set. Findings: Enhanced paediatric education is required before and after registration to ensure appropriate conveyance and address clinicians' lack of exposure, experience and confidence. Protocols and guidelines should be drawn up to support decision-making for lower-acuity child patients. Specialist paediatric roles are required in ambulance services to support clinicians and provide advanced patient-centred care. Conclusions: The findings of this review provide a basis for discussion and clinical practice improvement. Research to determine the clinical and cost effectiveness of implementing prehospital specialist paediatric roles is required. [ABSTRACT FROM AUTHOR]

Objective: Patient safety management systems in general hospitals require a comprehensive tool for assessing the expectations of inpatients across different wards. This study aimed to develop and psychometrically validate a new scale, the hospitalized patients' expectations for treatment scale-clinician version (HOPE-C), to meet this requirement. Methods: We interviewed 35 experts and 10 inpatients while developing the HOPE-C scale. The scale was initially designed with three dimensions: clinicians' expectations regarding doctor-patient communication, clinicians' expectations regarding treatment outcome, and clinicians' expectations regarding disease management. We recruited 200 inpatients from a general hospital in China. At the same time, 51 clinicians were assigned to the enrolled patients who completed the HOPE-C to examine the reliability, validity, and psychometric characteristics of the questionnaire. We applied item analysis, assessed construct validity, evaluated internal consistency, and conducted a test-retest reliability analysis over 7 days. Results: Both exploratory and confirmatory analyses supported a 2-dimensional structure, comprising doctor-patient communication expectations and treatment outcome expectations, with favorable model fit parameters (root mean square residual [RMR] = 0.042, root mean square error of approximation [RMSEA] = 0.049, comparative fit index [CFI] = 0.989, Tucker-Lewis index [TLI] = 0.984). Item analysis demonstrated appropriate item design (r = 0.744-0.961). The scale exhibited strong internal consistency, with Cronbach's a values of 0.884, 0.816, and 0.840 for the overall scale, the doctor-patient communication expectation subscale, and the treatment outcome expectation subscale, respectively. The 7-day test-retest reliability was 0.996 (p < 0.001). Conclusion: Our findings suggest that the HOPE-C is a reliable and valid assessment tool for measuring the expectations of inpatients in general hospitals. It effectively identifies patients' expectations concerning doctorpatient communication and treatment outcomes. [ABSTRACT FROM AUTHOR]

Artificially intelligent systems (AISs) are being created by software developing companies (SDCs) to influence clinical decision‐making. Historically, clinicians have led healthcare decision‐making, and the introduction of AISs makes SDCs novel actors in the clinical decision‐making space. Although these AISs are intended to influence a clinician's decision‐making, SDCs have been clear that clinicians are in fact the final decision‐makers in clinical care, and that AISs can only inform their decisions. As such, the default position is that clinicians should hold responsibility for the outcomes of the use of AISs. This is not the case when an AIS has influenced a clinician's judgement and their subsequent decision. In this paper, we argue that this is an imbalanced and unjust position, and that careful thought needs to go into how personal moral responsibility for the use of AISs in clinical decision‐making should be attributed. This paper employs and examines the difference between prospective and retrospective responsibility and considers foreseeability as key in determining how personal moral responsibility can be justly attributed. This leads us to the view that moral responsibility for the outcomes of using AISs in healthcare ought to be shared by the clinical users and SDCs. [ABSTRACT FROM AUTHOR]

Background: Due to recent advances in artificial intelligence, large language models (LLMs) have emerged as a powerful tool for a variety of language-related tasks, including sentiment analysis, and summarization of provider-patient interactions. However, there is limited research on these models in the area of crisis prediction. Objective: This study aimed to evaluate the performance of LLMs, specifically OpenAI's generative pretrained transformer 4 (GPT-4), in predicting current and future mental health crisis episodes using patient-provided information at intake among users of a national telemental health platform. Methods: Deidentified patient-provided data were pulled from specific intake questions of the Brightside telehealth platform, including the chief complaint, for 140 patients who indicated suicidal ideation (SI), and another 120 patients who later indicated SI with a plan during the course of treatment. Similar data were pulled for 200 randomly selected patients, treated during the same time period, who never endorsed SI. In total, 6 senior Brightside clinicians (3 psychologists and 3 psychiatrists) were shown patients' self-reported chief complaint and self-reported suicide attempt history but were blinded to the future course of treatment and other reported symptoms, including SI. They were asked a simple yes or no question regarding their prediction of endorsement of SI with plan, along with their confidence level about the prediction. GPT-4 was provided with similar information and asked to answer the same questions, enabling us to directly compare the performance of artificial intelligence and clinicians. Results: Overall, the clinicians' average precision (0.7) was higher than that of GPT-4 (0.6) in identifying the SI with plan at intake (n=140) versus no SI (n=200) when using the chief complaint alone, while sensitivity was higher for the GPT-4 (0.62) than the clinicians' average (0.53). The addition of suicide attempt history increased the clinicians' average sensitivity (0.59) and precision (0.77) while increasing the GPT-4 sensitivity (0.59) but decreasing the GPT-4 precision (0.54). Performance decreased comparatively when predicting future SI with plan (n=120) versus no SI (n=200) with a chief complaint only for the clinicians (average sensitivity=0.4; average precision=0.59) and the GPT-4 (sensitivity=0.46; precision=0.48). The addition of suicide attempt history increased performance comparatively for the clinicians (average sensitivity=0.46; average precision=0.69) and the GPT-4 (sensitivity=0.74; precision=0.48). Conclusions: GPT-4, with a simple prompt design, produced results on some metrics that approached those of a trained clinician. Additional work must be done before such a model can be piloted in a clinical setting. The model should undergo safety checks for bias, given evidence that LLMs can perpetuate the biases of the underlying data on which they are trained. We believe that LLMs hold promise for augmenting the identification of higher-risk patients at intake and potentially delivering more timely care to patients. [ABSTRACT FROM AUTHOR]

To explore the personal and system factors that motivate and enhance outcomes for patients accessing a prosthetic service and using a lower-limb prosthesis within a low resource setting. This study employed a qualitative approach to explore the motivations and satisfaction of individuals with lower limb loss engaging with a prosthetic service in Mombasa, Kenya. In-depth interviews were conducted over Microsoft Teams with 10 lower limb prosthesis users and thematic analysis was applied. Five key themes emerged: acceptance, self-determination, hope, clinician relationship and perception. These findings demonstrate the importance of hopeful thinking and a supportive community in overcoming physical and stigmatising challenges. The findings further highlight the value of the service provider relationship beyond just prescribing an assistive device. These results have relevance in developing patient-centred services, assistive devices and personnel training that are responsive, motivating, and cognisant of the service user. This is of particular interest as assistive technology services are newly developed in low resource settings. This research provides an understanding of lower-limb prosthesis users' satisfaction of a device and motivation for engaging with a prosthetic service within a low resource setting. The relationship the rehabilitation professional has with the service user plays a significant role in facilitating motivation during rehabilitation. Rehabilitation professionals should consider how they can foster a network of support amongst service users when planning services in remote, rural locations. Rehabilitation professionals should be aware of how hopeful thinking can be facilitated during rehabilitation to support motivation. When reviewing the success of services, or designing new service models, the service users should be consulted on what they would deem as a successful outcome. [ABSTRACT FROM AUTHOR]

The treatment of critically ill patients remains an evolving and controversial issue. Mechanical circulatory support through a percutaneous approach for the management of cardiogenic shock has taken place in recent years. The combined use of IABP and the Impella 2.5 device may have a role to play for this group of patients. A simulation approach may help with a quantitative assessment of the achievable degree of assistance. In this paper, we analyse the interaction between the Impella 2.5 pump applied as the LVAD and IABP using the numerical simulator of the cardiovascular system developed in our laboratory. Starting with pathological conditions reproduced using research data, the simulations were performed by setting different rotational speeds for the LVAD and driving the IABP in full mode (1:1) or partial mode (1:2, 1:3 and 1:4). The effects induced by drug administration during the assistance were also simulated. The haemodynamic parameters under investigation were aa follows: mean aortic pressure, systolic and diastolic aortic pressure, mean pulmonary arterial pressure, mean left and right atrial pressure, cardiac output, cardiac index, left and right ventricular end-systolic volume, left ventricular end-diastolic volume and mean coronary blood flow. The energetic variables considered in this study were as follows: left and right ventricular external work and left and right atrial pressure-volume area. The outcome of our simulations shows that the combined use of IABP and Impella 2.5 achieves adequate support in the acute phase of cardiogenic shock compared to each standalone device. This would allow further stabilisation and transfer to a transplant centre should the escalation of treatment be required. [ABSTRACT FROM AUTHOR]

• Clinician survey of 51 UK-based clinicians working with children with epilepsy. • 76–98 % of clinicians would refer children for presurgical evaluation at/before drug resistance development, in keeping with NICE and ILAE guidance. • Referral at/before epilepsy diagnosis was considered mostly in those with visible lesions (53 %) and those under two years (31 %). • Almost two-thirds (73 %) would consider early surgery before drug resistance is established. • Top outcomes to measure in an early surgery trial were seizure freedom (39 %) and quality of life (22 %). Many children with lesional epilepsies progress to drug resistance, a criterion required for surgical referral. Expedited surgery may reduce exposure of the developing brain to uncontrolled seizures, improving cognitive outcomes. Designing a trial comparing early surgery with standard care necessitates input from specialist clinicians regarding feasibility and measurable outcomes, which this study investigated. Online surveys were disseminated from June-July 2022 via regional paediatric epilepsy networks and professional societies. 51 UK clinicians responded, mostly paediatricians, paediatric neurologists and epilepsy specialist nurses. Candidacy for epilepsy surgery, outcome measures and support for the proposed study were surveyed. Clinician views were compared by speciality, using Pearson's chi-squared tests to explore differences. 76–98 % of clinicians would refer children for presurgical evaluation at/before drug resistance development across four subgroups (those younger/older than two years, and those with/without a detectable lesion). Earlier referral, at/before epilepsy diagnosis, was considered mostly in those with visible lesions (53 %) and those under two years (31 %). 73 % would consider early surgery before drug resistance is established. Top outcomes to measure were seizure freedom (39 %) and quality of life (22 %). Views of paediatric neurologists and paediatricians did not differ (p >.05). Clinician opinions generally aligned with published guidance regarding epilepsy surgery referral. Some remain cautious to refer young children with lesions prior to trialling more than one antiseizure medication. Most support early surgery in appropriate patients, with seizure and quality of life outcomes rated highly. Incorporating these perspectives will aid future trial design, recruitment and clinical utility. [ABSTRACT FROM AUTHOR]

Completion of an advance care planning (ACP) process and/or an advance directive should result in patients receiving the care they desire at the end of life. However, three decades of research have shown that is just not the case. ACP has been a front runner in developing the science within palliative care. Some positive outcomes such as lowering levels of surrogate grief may be associated with ACP. Yet, it does not appear that further ACP research will ensure that seriously ill patients will get goal-concordant care. An unfortunate consequence of palliative care research and advocacy so far is the misguided notion of many hospital systems trying to solve their palliative care problems by only implementing an ACP initiative. At best, ACP is but one tool in the collective palliative care toolbox. New tools are needed. Given that we have finite resources, future research should focus more on tools to improve symptom management, better models of care, and systems that will ensure goal-concordant care that meet the needs of the population that the health care system is designed to meet.

Abstract Background Mental health acute and crisis care consumes a large share of mental health budgets internationally but is often experienced as unsatisfactory and difficult to access. As a result, there is an increasing move towards developing innovative community crisis services, to improve patient experience and relieve pressure on inpatient and emergency services. This study aims to understand what helps and hinders the implementation of innovative mental health crisis care projects in England. Methods Using a qualitative approach, 18 interviews were conducted with crisis care service managers exploring their experiences and views of the development and implementation of their service developed with support from an English national capital funding programme. A framework analysis was conducted informed by implementation science. Results Key facilitators to implementation of innovative crisis services included bottom-up development, service user involvement, strong collaborative working, and leadership and management buy-in. Key barriers that affected the projects implementation included the complexities of crisis care, workforce challenges and resourcing issues. Conclusion There is a recognised need to improve, update, and innovate current crisis care offers. Results from this study suggest that a range of models can help address the heterogenous needs of local populations and that new approaches can be implemented where they utilise a whole-systems approach, involving service users and relevant professional stakeholders beyond mental health services in planning and developing the service.

Abstract Rationale Enhancing health system effectiveness, efficiency, and appropriateness is a management priority in most world countries. Scholars and practitioners have focused on physician engagement to facilitate such outcomes. Objectives Our research was intended to: 1) unravel the definition of physician engagement; 2) understand the factors that promote or impede it; 3) shed light on the implications of physician engagement on organizational performance, quality, and safety; and 4) discuss the tools to measure physician engagement. Method A scoping review was undertaken. Items were collected through electronic databases search and snowball technique. The PRISMA extension for Scoping Reviews (PRISMA-ScR) statement and checklist was followed to enhance the study replicability. Results The search yielded 16,062 records. After an initial screening, 300 were selected for potential inclusion in this literature review. After removing duplicates and records not meeting the inclusion criteria, full-text analysis of 261 records was performed, yielding a total of 174 records. Discussion Agreement on the conceptualization of physician engagement is thin; furthermore, scholars disagree on the techniques and approaches used to assess its implementation and implications. Proposals have been made to overcome the barriers to its adoption, but empirical evidence about implementing physician engagement is still scarce. Conclusions Our scoping review highlights the limitations of the extant literature about physician engagement. Physician engagement is a relatively ill-defined concept: developing an evidence base for its actual implementation is necessitated to provide reliable guidance on how the governance of health care organizations could be improved. Although we did not assess the quality or the robustness of current empirical research, our findings call for further research to: 1) identify potential drivers of physician engagement, 2) develop dependable assessment tools providing health care organizations with guidance on how to foster physician engagement, and 3) evaluate engagement’s actual impact on health care organizations’ performance.

Anxiety in older individuals is understudied despite its prevalence. Investigating its occurrence can be challenging, yet understanding the factors influencing its recurrence is important. Gaining insights into these factors through an explainable, probabilistic approach can enhance improved management. A Bayesian network (BN) is well-suited for this purpose. This study aimed to model the recurrence of anxiety symptomatology in an older population within a five-month timeframe. Data included baseline socio-demographic and general health information for older adults aged 60 years or older with at least mild depressive symptoms. A BN model explored the relationship between baseline data and recurrent anxiety symptomatology. Model evaluation employed the Area Under the Receiver Operating Characteristic Curve (AUC). The BN model was also compared to four machine learning models. The model achieved an AUC of 0.821 on the test data, using a threshold of 0.367. The model demonstrated generalisation abilities while being less complex and more explainable than other machine learning models. Key factors associated with recurrence of anxiety symptomatology were: “Not being able to stop or control worrying”; “Becoming easily annoyed or irritable”; “Trouble relaxing”; and “depressive symptomatology severity”. These findings indicate a prioritised sequence of predictors to identify individuals most likely to experience recurrent anxiety symptomatology.

Abstract Backgound Efforts to measure performance and identify its driving factors among clinicians are needed for building a high-quality clinician workforce. The availability of data is the most challenging thing. This paper presented a summary performance measure for clinicians and its application on examining factors that influence performance using routine patient-based records. Methods Perfomance indicators and difficulty score were extracted from electronic medical records (EMRs). Difficulty adjustment and standardized processing were used to obtain indicators which were comparable between specialties. Principal component analysis (PCA) was used to estimate the summary performance measure. The performance measure was then used to examine the influence of person-job fit and burnout through a mediator effect model and cluster analysis. Results A valid sample of 404 clinicians were included in this study, and 244 of them had valid response in the questionnaire. PCA explained 79.37% of the total variance presented by the four adjusted performance indicators. Non-performance attributes and performance driving factors help distinguish different clusters of clinicians. Burnout mediates the relationship between person-job fit and performance in a specific group of clinicians (β = 0.120, p = 0.008). Conclusions We demonstrated the analytical steps to estimate clinicians’ performance and its practical application using EMRs. Our findings provide insight into personnel classified management. Such practice can be applied in countries where electronic medical record systems are relatively less developed to continuously improve the application of performance management.